LAUSR

ABSTRACT Introduction: Thyroid eye disease (TED) is the most common orbital disorder, resulting from an immune-mediated inflammation and enlargement of orbital fat and muscle. It affects females five times more frequently than males and may severely impact cosmesis and visual function. Immuno-modulating medicine and/or radiotherapy are offered during the early progressive phase to lessen the risk of development of serious disease outcomes. Surgery plays an important role in disease management: it may be offered in the active phase to reverse vision loss from compressive optic neuropathy or corneal exposure, but is more commonly performed in the quiescent phase, for proptosis, ocular misalignment or lid malpositions. Areas covered: This article reviews challenges and developments in established and novel non-surgical and surgical therapies for TED. Expert commentary: New medications and radiotherapy may prevent serious disease sequelae and hopefully reduce need for surgery. Restorative surgeries such as orbital decompression, strabismus and eyelid surgery are constantly evolving to improve approaches and instrumentation and to avoid common complications.